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LeanHarbor Land Disposal Restriction Page : 1 of <br /> Notification Form <br /> ENVIRONMENTAL SERVICES° Printed Date :Mar 03, 2017 <br /> s === == -- --- - - - - - - - - --- --==—s=® = ==�� �� _ _ _ _ _ _ _ _ _ _ _ _ — <br /> _ _ I EST INFORMATION <br /> — _ . <br /> - - - - -- -- - - -- - - -- -- -- - --- <br /> Generator: City of Manteca 7 - - - -- - -- - -- - - - <br /> I _ Manifest Tracking Info. <br /> Address: 1001 West Center Street <br /> Manteca,CA 95337 O /5�1 <br /> EPA ID#: CAL 0 0 0 0 9_5_9 9 6 _ _ — —Sales Order No: 1701080820 JJ <br /> LINEITEMINFORMATIO_N__ _ _- - - - - -- --- --- - -- <br /> Line Ilam: rage No: Profile No: Treatability Group: I LDR Disposal Category <br /> 1 11 H13123128 —+ON-WASTEWATER —� 10(Alternate Soil Std-does not meet std. <br /> --- - - <br /> _L ———— ——i — —_—— —L ——— —— (with characteristic hazardous waste only)) <br /> EPAWasteCode - ---- - - - - -- - -- ----- <br /> - - - - - -- - - --- --- - - ----- -- -- -- - I EPA WasteSubCategorL — —— — — — ———— _ <br /> D008 i Toxicity Characteristic for Lead <br /> Certification <br /> Applies to <br /> I Manifest Line <br /> -- - - ------ - - - - - -- - _ __ _ I IRoms <br /> I certify under penalty of law that I personally have examined this contaminated soil and it does not contain+. <br /> listed hazardous waste and does exhibit a characteristic of hazardous waste and requires treatment to <br /> meet the soil treatment standards as provided by 268.49(c). I <br /> --- ---- - ------ - - - ---- ----- --- - <br /> Waste analysis data, ere avail a is attached. — — —i ——— — — — <br /> Signature s _ <br /> Print Name S <br /> Title : M _Date: 4 Nvar� Z_t <br /> -- --- - <br /> - ----- - - --- - --- - - ------- - - --- - - -- - - - - <br />